I feel as if I have a season pass there because this is one heck of a roller coaster. Dr. Bromberg came by this evening and asked about his day. He had generally the same amount of awake/asleep time but did eat a bit more. He said that the function on the echo looks better than Saturday, and frankly, doesn't see a difference between his echo in October and his echo today. He emphasized how hard he's been looking at his records side by side and how he really feels he knows now what is going on with Connie. He says he thinks this is the atrial flutter and knowing how sick he was when he came back from Michigan and how long it took him to recover, he just thinks we're kind of facing the reality that he takes longer to bounce back. He thinks this is going to take some time. His INR levels came back saying he's already in the target range meaning he's on too much coumadin and we cut his dose in half. We'll check levels again soon to see how he is doing. He thinks that we can manage this and keep him out of the hospital with lasix, coumadin, digoxin and raising his enalapril considerably. He's going to try to turn off the milrinone tomorrow and if he goes 24 hours with no milrinone and is able to eat enough without vomiting and staying awake a bit more then we will be looking at maybe getting out of here on Wednesday some time! We'd then be looking at outpatient labs on Friday and going into the office to be checked out and then again to the office on Monday and scheduling the cardioinversion for Tuesday of next week. It's kind of a balance between doctor schedules and where Connie is clinically. His blood is already in the thinned target range so that lowers the risk of there being a clot. Dr. Bromberg said the timing of it is a matter of him weighing the risks and benefits. We talked some time about the possibility of pacing both chambers since presently he is only being V-paced. He said that it wouldn't prevent this from happening again. He already has a lead on his atrium and Dr. Bromberg could turn it on. Right now it is only set to beat if his rate dips below 80. He said it wouldn't matter if the beat was generated from his atrium or from the pacemaker. The problem is when the signal hits scar tissue and goes haywire.
I did get teary when I told him I was scared to death he was going to make us drop an NG tube. He said just keep trying to sneak what we can in him. We are literally aggravating him to death with offers of food and drink. I pretty much stand there with a cup in his face while he plays or watches a movie, but I guess that is what it's going to take for awhile.
So, it was a good visit and we are hopeful for another day of med tweaking rather than surgery prepping.
Keep the prayers coming. Pray specifically for Connie to regain some appetite and tolerate eating. Also pray that his heart tolerates losing the assistance of the milrinone tomorrow.